INTRAUTERINE INFECTION. SEPSIS.

LOCAL PYO-
INFLAMMATORY DISEASES

Utero infection
Fetal infection * (VUI) - disease of the fetus or newborn, which arose because of its antenatal or
intrapartum infection causative agent of an infectious disease.

At present, adequate statistical data on the VUI are absent, however, there are some studies that
hint at the wide spread of VUI. Thus, on average, in 33% of women of childbearing age and in
60-80% of patients considered to be at high risk of cervical mucus from Channel detect
cytomegalovirus and herpes simplex virus. The normal vaginal microflora reveal less than 50%
of pregnant women. It is believed that in Russia the frequency of infection of the fetus reaches
20%, and neonatal infection is 3-9%. In the last decade can be traced a clear tendency to increase
the proportion VUI structure of perinatal mortality (mainly due to improved diagnosis). The
frequency of infection to some extent depends on the epidemiological situation and is
particularly high among populations with low social status.

Etiology and pathogenesis

Most VUI is mixed viral (80%) and viral and bacterial microflora of the toes. It is also possible
intrauterine infection protozoy-governmental diseases (eg, toxoplasmosis, malaria). Antenatal
infection of the fetus most often occurs transplatsen -

packaged, rarely by infected amniotic fluid.

-- Transplacental infection occurs by cytomegalovirus, herpes simplex virus types 1 and 2,

rubella virus, hepatitis B and C and HIV. Among the viral association is dominated by
enteroviruses Coxsackie viruses B or influenza A or C in combination with herpes simplex virus
or cytomegalovirus. It is believed that when a heavy defeat in its fetal infection is involved at
least three different viruses. For most bacteria and protozoa placental barrier impenetrable, but
infection can occur when damage to the placenta and the formation of chronic fetoplacental
insufficiency.

-- Infection of the amniotic fluid is rising (with localization of the pathological process in the
vagina or cervix), downward (when the pathogen from penetrating the abdominal cavity through
the fallopian tubes) and contact (with the inflammatory process in the uterus and placenta) by. In
such cases, the infection may not only viruses, but fungi, bacteria (mainly opportunistic),
mycoplasmas, trash-diyami. The most severe, septic, forms VUI develop during infection of the
placenta, by contact from infected amniotic fluid.
 Intrapartum infection is typical for herpes, mycoplasma-term and chlamydial infections. You
may, however, and intrapartum infection by bacteria. In this case, agents are more often VUI
representatives conditionally pathogenic gram microflora (Escherichia and Pseudomonas
aeruginosa, Klebsiella, Proteus), staphylococci and p-gemoli-cal Group B streptococci,
gonococci.

Risk VUI is linked not only with acute infectious diseases during pregnancy, as with the
presence of the future mother of chronic diseases and various complications of pregnancy. VUI
not found an association with the presence of acute respiratory viral infection or exacerbation of
herpes infection during pregnancy.

Clinical picture

The clinical picture VUI essentially depends on the time and ways of becoming infected.

8.10 In the first week of intrauterine development is only possible alter-tional phase of
inflammation, the process ends with either death of the embryo or the formation of congenital
malformations.

Later onset and proliferative component of inflammation. Injection at later stages (11-28
weeks) causes a proliferation of connective tissue (eg, fibroelastoz infarction), Display Zia and
hypoplasia of the internal organs, intrauterine fetal development and generalized infectious
process.

When infection of the fetus after 28 weeks involved three components of inflammation -
alterativny, proliferative and vascular.

-- In localized forms VUI is the defeat of the internal organs (fetal hepatitis, gepatolienalny
syndrome, cardiomyopathy, in-terstitsialny nephritis, intrauterine pneumonia, enterocolitis, and
others), and 1 central nervous system (encephalitis or meningoencephalitis). The formation of
brain fruit continues throughout pregnancy, so congenital malformations, and CNS lesions
register more often than the pathology of other organs. Because the clinical manifestations VUI
are mostly nonspecific, in most cases exhibit diagnosed with perinatal encephalopathy "or"
cerebrovascular accident ".

-- The clinical picture in generalized VUI resembles sepsis (the defeat of the internal organs,
hemolytic anemia, thrombocytopenia, hemorrhagic syndrome, adrenal insufficiency, infectious
toxicosis).

-- Perhaps asymptomatic beginning with subsequent deployment of the clinical picture (delayed
pathology): hypertension-hydrocephalic syndrome, progressive cataract, diabetes, hepatitis, and
pathology of urinary system, etc.

DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS

Methods of diagnosis VUI can be divided into two groups: direct and indirect.

Direct methods

Direct methods of research aimed at identifying the causative agent or its Ag in the body of a
sick child.

Microscopic (bakterioskopichesky) method.

The culture method (seeding of biological fluids and secretions in the patient's specific
environment), the most accurate, but it is rarely used because of the high cost and the duration of
the study (from 3 to 20 days).

Molecular-biological methods. Most widely polymerase chain reaction (PCR), can detect a
minimal amount of DNA of the parasite. The results were assessed in comparison with data from
other laboratory methods and clinical manifestations. To address the question of the activity of
the process and the effectiveness of treatment using a combination of PCR and serological
methods, as well as parallel to explore the serum of the child and mother-in dynamics (rise AT
titer using the method of paired sera).

With immunosorbent assay (ELISA) and the reaction immunoflyu-orestsentsii (RIF) identify
the specific Ag.

Indirect (serological) methods

In evaluating the data of serological studies newborn into account the results of similar tests in
the mother. Diagnostic criterion VUI is increasing titer of IgG in the sera of newborn and 4-fold
increase compared with the titer AT mother (IgG - the only class of Ig, penetrating through the
placenta). Some importance is the definition of avidity index that characterizes the strength of
binding of Ag with AT.Vysokoavidnye IgG in the serum of the child are usually the
parent. Availability nizkoavidnyh IgG indicates their synthesis by the body baby, ie, infection of
the child. Detection of IgM in the newborn in the first days of life - irrefutable proof of
intrauterine infection, because IgM does not pass through the placenta and the first of Ig appear
in response to the presence of Ar. Note, however, that the presence of the pathogen does not
always lead to disease, and therefore can not be equated with intrauterine infection and VUI.

In terms of composition and quantity of Ig pregnant can judge the likelihood of developing a
VUI.

Detection of specific IgG in a pregnant in a small number indicates that it accordingly Ag

immunization in the past. In such cases, there is no risk to the fetus. Fruit gets maternal IgG,
which provides him immune protection in the first 4-6 months of life.
 The increase in titer of specific IgG or IgM indicates the occurrence of relapse of infection
during pregnancy. In such a case should be retested. The probability of infection of the fetus is
8%.

With persistent infection in the blood of a pregnant detect parasite Ag and IgG, a IgM
lacking. In this case, the probability of transmission to the fetus is 2%.

In primary acute infection in previously seronegative women find only IgM (IgG yet). The
causative agent of the disease infects the fruit of more than 50% of cases, often causing a
generalized form VUI.

Infection of the fetus can result in an infectious process, the readjustment of the organism with
the formation of immunity or carriage of the development of delayed pathology. Therefore, it
makes no sense to conduct laboratory diagnostics VUI all newborns (AT may be present in the
body due to the fact that the child is in contact with the agent or tolerate infection in a latent form
when there is no need for treatment). Survey shows with suspected VUI, and hold it is necessary
in the first hours of life, as at a later date the positive results are possible and postnatal
infection. It is believed that the benefit of VUI show positive results obtained in the first 7 days
after birth, and cultures using the method of detecting the pathogen in biological fluids - in the
first 3 weeks of life. Serology results for VUI may be negative if the Ig fusion is not enough of
due to weak antigenic stimuli or as a result of immunodeficiency (eg, preterm).

Additional research

In general, blood analysis can detect leukocytosis with a marked leftward shift in the leukocyte
formula, lymphocytosis with neutropenia, monotsi-inos, thrombocytosis, toxic granularity of
neutrophils, anemia.

If you suspect a VUI is advisable to cerebral ultrasound, as in many fetal lesions suffered
CNS. Possible changes in cerebral ultrasound: periventricular leukomalacia, calcium-fikaty,
cysts in the substance of the brain, ventriculitis, choroiditis, vnutrizheludochko-vye hemorrhage,
or diffuse periventricular hyperechogenic. These changes, as well as the clinical manifestations
are nonspecific.

DIFFERENTIAL DIAGNOSIS

Differentiate VUI should be primarily on diseases of the fetus, caused by hypoxia, leading to
subsequent metabolic disturbances. These include hypoxic-ischemic encephalopathy (see above
section "Perinatal CNS lesions"), hypoxic myocardial damage, respiratory system, kidney
tissue. Due to the similarity of the clinical picture and results of ultrasound in these diseases the
main criterion for differential diagnosis are special studies (PCR, serological tests).

TREATMENT
Treatment at the VUI should be comprehensive and must include on-syndromic treatment (Table
6-2).

Table 6-2. The treatment in intrauterine infection

Therapies Note

I. Immunotherapy Normal human Ig (eg, intraglobin, sandoglobulin, oktagam), Ig

normal human (IgG + IgA + IgM) (for example, pentaglobin)
Ig:
Ig against cytomegalovirus (tsitotekt) nonspecific
- Polyvalent

- Specific

Immunomodulators (interferon)
il. Antiretroviral therapy (drugs 1. Aciclovir
directional)
2. Ganciclovir (because of toxicity did not designate the newborn)

[II. Antibacterial therapy III generation cephalosporin, aminoglycosides, carbapenems

broad spectrum antibiotics Azithromycin, roxithromycin, Midecamycin (makropen),

clarithromycin, spiramycin (rovamitsin), erythromycin in / in
Macrolides (for chlamydia and
mycoplasma infections)

Application of Ig - physiological and natural method of treatment, but at the same time,
mismanaged, as it does not guarantee the changes of the immune response in the right
direction. Sometimes the possible side effects of intravenous Ig: aseptic meningitis, pyrogenic,
vasomotor and anaphylactic reactions. Ig associated viruses only in the extracellular space
(suppressing viremia), but did not affect the virus is located within the cell. Therefore, required
refresher courses at intervals of 10-15 days.

Immunomodulators, such as interferons, appointed after antiviral therapy or concurrently with

Ig.

Because antiviral drugs directed action for the treatment of newborns only use acyclovir, the
drug injected intravenously for 14-21 days at a dose of 70-90 mg / kg / day in 3 divided doses.

Babies usually have to resort to empirical antibiotic otikoterapii using broad-spectrum

antibiotics (VUI often cause nosocomial strains resistant to many drugs). At present, most
commonly used combinations of III generation cephalosporins (ceftazidime, cefotaxime,
ceftriaxone, cefoperazone) with an aminoglycoside [netilmitsin (netromi-ching)]. It is widely
Netromycin combination with ceftriaxone, as these drugs are injected 1 time per day. In the
absence of the effect of using karbepenemy [imipenem + cilastatin (thienyl), meropenem (me-
ronem)] and glycopeptides, eg vancomycin, effective in 100% of the cases against staphylococci
(in contrast to the p-lactam antibiotics and aminoglycosides).

Given the lack of reliable diagnostic methods and means of ethio-tropic therapy, currently in
first place the therapy of certain manifestations of VUI (eg, perinatal CNS lesions, pneumonia,
myocarditis, hepatitis, hemolytic anemia, hemorrhagic syndrome). If the results of laboratory
tests are positive, but the characteristic clinical symptoms VUI absent from specific treatment
should be avoided.

PREVENTION

A survey of women to be at risk for VUI should begin before pregnancy, especially during her
planning in immunosuppressive therapy. Often, a survey should be repeated, for example, to
identify infectious disease, occurring in a latent form.

FORECAST

In generalized VUI unfavorable prognosis: mortality rate reaches 80%. In children, survivors of
severe forms of meningoencephalitis, or fetal hepatitis, forming coarse delay psychomotor
development or chronic hepatitis, respectively. In localized forms VUI prognosis mainly depends
on the presence of associated pathological conditions, timeliness and adequacy of treatment. The
most serious consequences resulting CNS lesions. However, in a localization process is not ruled
out a serious defeat of many organs (kar-diomiopatiya, fibroelastoz endocarditis, interstitial
nephritis, broncho-pulmonary dysplasia with formation of chronic respiratory disease, chronic
hepatitis with the outcome of cirrhosis, etc.). Little or asymptomatic VUI subsequently leads to
the development of delayed pathology.

Sepsis
Postnatal infection usually leads to the development of local gaoyno-inflammatory diseases, with
reduced immunity is possible generalization of infection to the development of sepsis. Sepsis -
polietiologicheskaya generalized form of infection, accompanied by a transient or primary
immunodeficiency, is not accompanied by any specific process in the body and is characterized
by systemic lesions and the presence of the pathogen in the blood.

Etiology and pathogenesis

Purulent-inflammatory diseases may be caused by more than 30 kinds of microorganisms. Until

recently, in sepsis frequently identified opportunistic Gram-negative flora. Predominated
neenteropato gene-intestinal and Pseudomonas aeruginosa, Klebsiella, Proteus, Group B
streptococci, Enterobacteriaceae. At the present time, as in 60-70-ies., Gradually becoming the
dominant flora Grampositive (most epidermal staphylococcus). In the last decade among the
pathogens neonatal sepsis met fungi, especially Candida albicans. newborn sepsis usually
develops on the background VUI, more commonly localized or low-symptomatic form. In such
cases, the typical version gipoergichesky flow sepsis, accompanied by hypocoagulation,
thrombocytopenia and neutropenia.

Clinical picture

Most gateway is umbilical wound. It is also possible entry of infection through the skin,
respiratory and digestive organs of hearing. Previously, it was customary allocation of two forms
of sepsis - septicemia and septo-kopiemii. Currently this division is of secondary importance.
When septicemia, the clinical picture dominated by symptoms of an infectious
toxicosis. Markedly affected the general condition: the dream is broken, the initial anxiety is
replaced by lethargy and weakness. Appear anorexia (the child is sucking weakly or refuses the
breast), srygiva-tion, sometimes with an admixture of bile, unstable stool.The child's body
weight decreases with enough milk from the mother. Reveal muscle hypotonia and hyporeflexia
(until the disappearance of physiological reflexes). For the skin characterized by paleness, and
then earthy color and marbling (Fig. 6.2 inset), possibly a rash. Body temperature is varied (from
hypothermia and subfebrile to hyperthermia and hectic fever). Chance of edematous syndrome.
In a breach of the microcirculation and metabolic changes develop pneumopathy (dyspnea,
cyanosis, abnormal type of breathing), cardiopathy (voiceless heart tones, the systolic sound,
hypotension, ECG changes in the P wave at the expense of metabolic abnormalities in the
myocardium, ST segment shift ), hepatosplenomegaly, jaundice, urinary syndrome,
gastrointestinal dysfunction (up to necrotizing enterocolitis). Chance hemorrhagic syndrome.

When pyosepticemia against the backdrop of severe intoxication appear purulent foci (often
multiple): abscess, phlegmon, osteomyelitis, purulent meningitis, pockets of destruction of the
lungs and other

There are lightning (1-7 days), acute (4-8 weeks, most often) and chronic or subacute (more than
6-8 weeks), during the disease. For lightning-fast flow of sepsis characterized by the
development of septic shock with hemorrhagic syndrome, a sharp decrease in blood pressure,
oliguria, this form is often fatal. Lightning form of sepsis is extremely reminiscent generalized
form VUI. Some authors call this form hyperergic sepsis, often causes disease streptococcus
group B.

DIAGNOSIS

Diagnosis of sepsis is complicated enough. In 60-70 years. due to lack of diagnostic criteria VUI,
primarily serological and virological, very often diagnosed with sepsis, "put in generalized forms
VUI, especially in severe cases with fulminant course and fatal outcome. In the diagnosis of
sepsis in recent years returned to the results of bacteriological studies of blood, from which the
70-80-ies. virtually abandoned. Now consider that the most reliable confirmation of the
diagnosis of "sepsis" is the provision of blood culture. In its allocation should take into account
the following points.
 Contact microorganisms in the nutrient medium may be in violation of the rules of asepsis
when taking blood.

The medium may be a non-sterile in violation of the rules of its preparation and storage.

Bacteraemia may be transient.

To confirm the diagnosis requires multiple studies. Other laboratory investigations (general and
biochemical blood tests, urine, etc.) in the diagnosis of sepsis are of secondary importance.

TREATMENT

Treatment of sepsis is aimed at suppressing the pathogen, increasing the protective properties of
organism, rescue purulent foci.

Antibiotikotersshiya

Antibiotic therapy is carried out simultaneously with two antibiotics (based on their synergy)
within 10-15 days of age, to the maximum dose, followed by the change agents. Preferably,
intravenous. Take into account the sensitivity of the pathogen to the antibiotic, and if the results
of a study on the sensitivity of not, prescribe broad spectrum antibiotics .

Posindromnaya therapy

They carry out detoxication therapy, correction of violations KSCHS, restoration BCC
intravenous solutions of glucose, albumin, plasma, gemodeza, reopolyglukine. When
hypercoagulable restore peripheral circulation (warm extremities, appoint antiagreganty,
reopolyglukine, heparin-controlled laboratory data). If you suspect hypocoagulation introduce
native frozen plasma. To increase the body's resistance is desirable to provide the child with the
parent native milk.

Localized suppurative-septic diseases

Localized suppurative-septic diseases in newborn infants often causes Staphylococcus aureus.

Omfalit

Omfalit - catarrhal or purulent inflammation of the umbilical area. Usually umbilical wound is
covered with epithelium until the 14 th day of life. When inflammation epithelization is delayed,
umbilical ring becomes edematous and hyperemic. In the umbilical wound appears serous-
purulent discharge. Sometimes the process goes on Environmental umbilical wound skin and
umbilical vessels, which become thickened and palpated in the form of rovings. Umbilical region
several vybuhaet. The said symptoms may involve a breach of the general condition of the child,
increased body temperature, the flattening of the growth curve of body weight and signs of
inflammatory response from the peripheral blood. When you spread inflammation of umbilical
vessels are possible umbilical vein thrombosis and the generalization process (umbilical sepsis).
Omfalit may end development phlegmon of the abdominal wall and peritonitis. If there is
discharge from the wound and the prolonged umbilical cord detachment of balance, especially in
children with high body weight at the bottom of umbilical lesions may appear granulation
mushroom shape - Fungus navel.

Treatment: Daily treatment of umbilical lesions 3% hydrogen peroxide solution followed by

drying 70% ethyl alcohol, 1-2% alcoholic solution of brilliant green or 3-5% solution of
potassium permanganate. Good effect, including those with purulent secretions, has a zinc
hyaluronate (kuriozin). Fungus navel sear solution of silver nitrate. Violation of the general
condition and the threat of generalization of infection, especially in premature and weakened
children, displaying antibiotics, infusion solutions of glucose, plasma, the introduction of Ig.

Syndrome of staphylococcal toxic epidermal necrolysis *

Syndrome of staphylococcal toxic epidermal necrolysis - a disease caused by Staphylococcus

aureus, works out eksfolia-cess in the toxin. Manifestations of the disease vary in severity from
erythema-toznyh spots to bullous lesions and a generalized exfoliative disease (Ritter's disease).
The disease usually develops in the 2-3rd week of life. At the skin surface are formed of
different size bubbles with turbid contents. Bubbles are localized mainly on the chest, abdomen,
inner surfaces of the limbs, easily burst, leaving the erosive surface. In the development of
disease Ritter desquamation of the epidermis is greater in layers exposing the papillary layer of
skin, which is often complicated by sepsis.

Treatment. If the bubbles themselves are not opened, they pierce. Exposed surface is treated
with 5% solution of potassium permanganate. Recovery is accelerated with antibiotics.

Abscess

Abscess - accumulation of pus surrounded by tissue with the formation of pyogenic membrane
abscess clinically characterized by hyperemia and infiltration of soft tissue and the fluctuations
in the center. Newborn fluctuation appears later than the image of purulent cavity, so if you
suspect that an abscess should be expected to produce a puncture ulcer.

Treatment. If there is pus produce section, which provides its outflow. Abscess cavity was
washed with antiseptic solution and establish drainage. With the threat of generalization of the
process and violation of the general condition of the child prescribed antibiotics. If the abscess is
a local manifestation of sepsis (septic focus) conduct appropriate treatment (see above section
"Sepsis").

Necrotic abscess newborn

Necrotic abscess newborns - purulent inflammation of the subcutaneous fatty tissue with its
melting and subsequent necrosis of the skin. The disease begins with a rapidly spreading skin
redness, and later appears infiltration. The process is progressing rapidly, seizing neighboring
unaffected areas.

Treatment: rapid (causing cuts in a checkerboard pattern with the seizure of healthy sites,
followed by washing with antiseptics and the provision outflow). Additionally prescribe
antibiotics.

Conjunctivitis Newborn

Conjunctivitis - a frequent disease of the newborn. Conjunctivitis may be catarrhal and

purulent. The disease occurs mainly as a local process; Infection usually occurs during the
passage of the fetus through the birth canal. For the disease characterized by marked edema and
hyperemia of the eyelids, which are sometimes difficult to extend, possibly purulent discharge.
With abundant purulent secretions should clarify the etiology of the disease on the results of
microscopic and bacteriological studies.

Treatment: rinsing with a weak solution of potassium permanganate, 6-10 times a day, followed
by burying 20% sulfatsil-sodium or solution of the antibiotic directed action (in elucidating the
pathogen).

Mastitis

Mastitis in children occurs on the background of physiological mastopathy. The disease

manifests redness and infiltration of the skin around the nipple. Treatment of suppurative
mastitis promptly.

Psevdofurunkulez

Psevdofurunkulez (multiple abscesses of the skin) develops due to the defeat of the excretory
ducts of the sweat glands of staphylococcal etiology with subsequent involvement in the process
throughout the sweat glands. The disease starts with the formation of dense nodules in the
subcutaneous tissue. Integuments over the bundle does not change. After 2-3 days the bundle
increases, reaching size of the forest, or walnut. The skin becomes stagnant red hue
infiltrating. Later in the center of infiltration appears fluctuation. Multiple abscesses outwardly
resemble boils, but differ from the latter lack the characteristic dense infiltrate and necrotic core.

Treatment. Pustules reveal obtained pus sent for bacteriological study. After opening the
pustules and smearing them with solutions of aniline dyes applied ointment with antibiotics. For
resorption of infiltrates in the trunk and extremities prescribe physical therapy (UHF).

Oral candidiasis

Oral candidiasis (thrush) is characterized by the appearance of a slightly rising white plaque on
the oral mucosa. If you remove plaque exhibit hyperemic, slightly bleeding surface. Pathogen -
 Candida albicans. The disease usually occurs in poor care in debilitated children and in
immunodeficient states.

Treatment. Treatment of oral 2.4% sodium bicarbonate, aqueous solutions of aniline dyes.

Diaper dermatitis

Diaper dermatitis - recurring pathological condition baby's skin triggered by exposure to

physical, chemical, enzymatic and microbial factors in the use of diapers or diapers.

The disease begins with the appearance of mild redness, mild rash and severe flaking of the skin
in the genital area, buttocks, and lower segments of the abdomen and lower back. In the future, if
the action of an irritant is not removed, the skin there are papules, pustules, in skin folds can
form small infiltrates, become infected with bacteria and Candida albicans. In long-term course
of the disease formed discharge infiltrates, papules, vesicles, wet, deep erosion.

Treatment. Hygroscopic must use disposable diapers, show the frequent changes of diapers
(including at night). The affected skin is applied with a powder of zinc oxide and talc, and zinc
paste. When candidiasis or persistent rash affected areas treated with antiseptic solution (dye ),
with each change of diaper cream or powder applied with the antifungal drugs (miconazole,
clotrimazole, ketoconazole).

Osteomyelitis

Osteomyelitis - inflammation of the bone marrow, extending to the compact and cancellous bone
and periosteum. Osteomyelitis in infants is localized mainly in the epiphysis of long tubular
bones, often with damage to a nearby joint. The most frequent causative agent of osteomyelitis -
Staphylococcus aureus. The disease begins with the appearance of acute intoxication, fever,
limiting the mobility of limbs, pain during passive motion or palpation. 2-3 days appear swollen
and smoothed contours of the joint, and then swelling and infiltration of soft
tissues. Radiographic changes appear after 2 weeks. Currently, subacute osteomyelitis often
occurs without severe intoxication, and occurs mainly restricted mobility of the limbs and pain
reaction in the passive movements.

Treatment operative (osteoperforatsiya, drainage and providing flow washing).

Meningitis

Meningitis - inflammation of the membranes of brain and / or spinal cord - one of the most
severe and life-threatening forms of purulent infection in the newborn. The disease can cause
Group B streptococci, E. coli, especially in children the first week of life, as well as
Staphylococcus, Listeria, Klebsiella, and al predisposing factor - perinatal CNS lesions.
Meningitis can be an independent disease or a manifestation of sepsis (abscess metastasis).
Symptoms are usually nonspecific. Note the inhibition of the Child periodically replaced anxiety,
decreased appetite or refusal of the chest, regurgitation, fever, pale skin, acrocyanosis, abdominal
distension, signs of increased intracranial pressure ( "brain" scream, tense fontanel vybuhayuschy
or any increase in head circumference, vomiting). It is also possible tremors, hyperesthesia, a
symptom Grefe, floating movement of the eyeballs, convulsions. Neck stiffness and other
meningeal signs usually appear in the later stages of the disease.

If you suspect meningitis, lumbar puncture is required. In purulent meningitis opalescent or

turbid liquor flows under increased pressure, frequent drops or stream. Cytosis predominantly
neu-rofilny. In addition to high neutrophil cytosis characterized by low concentrations of
glucose, increased protein concentration. Needed tank terioskopicheskoe and bacteriological
study of sediment liquor. Investigation of cerebrospinal fluid is repeated every 4-5 days until
complete recovery.

Treatment. Antibiotic therapy - the main type of treatment for meningitis. Uses antibiotics,
good penetration through the BBB [ceftriaxone, ceftazidime, cefotaxime, gentamicin,
amoxicillin, meropenem (Meron), vancomycin], the maximum age-dose, long course with the
change of drugs in 1-2 weeks. Additional introduction of antibiotics endo-lumbar or the
ventricles of the brain has no additional effect. The child also appointed detoxic,
protivosudorozh-tion and dehydration therapy. When cerebral edema appoint
dexamethasone. You can apply specific Ig directed action.

PREVENTION OF INFECTIOUS DISEASES

Prevention of infectious diseases in newborns provides:

timely identification and rehabilitation of chronic foci of infection in pregnant women, warning
her of acute infections;

creation of home and enterprise environment for the favorable course of pregnancy, giving
birth to the term;

proper labor management, prevention, and traumatic infection of the fetus, especially when
vaginal studies, premature discharge of amniotic fluid, the use of obstetric benefits;

compliance staff in maternity wards anti-epidemic measures and rules of personal hygiene;

early initiation of breastfeeding.